Provider Demographics
NPI:1154314482
Name:TORRES, WANDA (MD)
Entity Type:Individual
Prefix:DR
First Name:WANDA
Middle Name:
Last Name:TORRES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2044 TRINITY OAKS BLVD STE 125
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-4405
Mailing Address - Country:US
Mailing Address - Phone:727-376-0060
Mailing Address - Fax:866-551-6104
Practice Address - Street 1:2044 TRINITY OAKS BLVD STE 125
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-4405
Practice Address - Country:US
Practice Address - Phone:727-376-0060
Practice Address - Fax:866-551-6104
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75408207VX0000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2815265OtherAETNA HMO
FLP11023634OtherMULTI PLAN
FL43339OtherBLUECROSS BLUESHIELD
FL7255367OtherAETNA PPO
FL09816010003OtherCIGNA
FL254285400Medicaid
FL2815265OtherAETNA HMO
FL7255367OtherAETNA PPO